In M mode, the structure used to pinpoint end systole for measurement is:

A.) The R wave of the ECG.B.) Maximum anterior motion of the left ventricular posterior wall.
C.) Maximum posterior motion of the interventricular septum.
D.) The Q wave of the ECG.

B.) The R wave denotes the electrical stimulation that initiates systole. The Q wave is not always present and is not an indicator of end systole. Although the septum is at its maximum posterior motion under normal conditions, it is susceptible to electrical aberrations and volume and pressure changes and therefore not consistent for measurement. Only the maximum anterior motion of the left ventricular posterior wall is consistent for end-systolic measurement.

B.) Systolic click. Systolic clicks are among the most important physical findings in patients with mitral valve prolapse. The clicks may be single or multiple and may be brought out by changes in position or by using the Valsalva maneuver.

B.) Opening snap. The sounds are sharp and high- pitched. In isolated mitral stenosis, increasing severity of the lesion causes higher atrial pressures and early opening of the valve. A relatively short interval between the aortic component of the second heart sounds and the opening snap (A2-OS interval) implies severe mitral stenosis. A pericardial knock, which occurs with constrictive pericarditis, is an early diastolic sound that can be confused with an opening snap.

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Early diastolic murmurs are due to aortic or pulmonic insufficiency.

True or False.

True: The severity of regurgitation is often inversely related to the duration of the murmur. With severe regurge, aortic diastolic pressure falls rapidly and may equalize with ventricular pressure relatively early, causing marked reduction of intensity or cessation of the murmur. Aortic insufficiency may also cause a diastolic rumble at the apex- an Austin-Flint murmur. Pulmonary insufficiency due to pulmonary hypertension, there is a large diastolic gradient. The murmur is high- pitched, follows the second heart sound immediately, and continues throughout diastole. In pulmonary insufficiency caused by valvular disease, there is usually a silent period b/w the pulmonic second heart sound and the initiation of the murmur, which is relatively low in frequency.

Myxomas are tumors that can be located either inside or outside the heart.

True or False.

False. These tumors are located only intracardially.

Approximately 40% of patients with left atrial myxomas have systemic emboli to the brain or extremities.

True or False.

True.

Myxomas occur only in the left atrium.

True or False.

False. Myxomas can occur in either atrium, on the mitral valve, or in the ventricles.

Females are affected slightly more often than males.

True or False.

True.

Symptoms associated with pericarditis include:

a.) A severe, sharp pain located precordially that may radiate into the shoulders and neck.
b.) Ankle swelling.
c.) Changing positions and taking deep breaths increases the pain.
d.) The pain is dull and radiates into the jaw.

C.) Increase velocity. A reduction in vessel diameter increases velocity within the constricted segment. A reduction in vessel diameter also increases the likelihood of turbulence, and if the diameter is sufficiently reduced, flow will be reduced (critical stenosis).

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Which one of the following is most likely to cause turbulent flow of blood in the aorta?

A.) An increase in cardiac output from 5 L/min to 20 L/min.
B.) An increase in arterial pressure of 5 mm Hg.
C.) A decrease in cardiac output to one-half of normal.
D.) A hypertensive episode.
E.) An increase in hematocrit.

A.) An increse in cardiac output from 5 L/min to 20 L/min.

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Which of the following are characteristics of turbulent flow?

a.) It can be predicted by Reynold's number.
b.) It is responsible for murmurs, bruits and thrills.
c.) It increases pressure downstream.
d.) It occurs where there are abrupt variations in vessel diameter.
e.) It is affected by velocity.

All of the above except for c.

During and experiment, a laboratory animal suddenly develops 2:1 heart block, effectively reducing heart rate by one-half. Which ONE of the following responses would account for pressure being maintained at the same level as before the heart block?A.) Peripheral resistance doubled.
B.) Arteriovenous shunting.
C.) Peripheral resistance decreased by one-half.
D.) Massive vasodilatation of the arterial sphincters.
E.) Peripheral resistance unchanged.

A.) See the analogy to Ohm's law. Cardiac output and pressure are governed not by how much blood the heart can put out in a given period but rather by how much blood the peripheral vessels are capable of accepting. With cardiac output halved and peripheral resistance doubled, pressure remains the same.

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A subject has a cardiac output of 5 L/min at a heart rate of 75 beats/ min. If stroke volume remains constant, what will be the effect of an increase in heart rate to 150 beats per minute?

Which ONE of the following statements is True regarding the term blood pressure?

A.) It is constant throughout the cardiac cycle.
B.) It represents and can be used interchangeably with flow.
C.) It is the same as hydrostatic pressure.
D.) It is reported in cm H2O unless otherwise specified.E.) It represents the force exerted by the blood against any unit area of the vessel wall.

E.) It represents the force exerted by the blood against any unit area of the vessel wall.

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The minimal pressure in the arterial system during a cardiac cycle is termed:

In measuring human blood pressure, the first sound was heard at 130 mmHg, the second at 105, the third at 100, and the last at 95. What is the estimated mean blood pressure?

A.) 118 mmHg.
B.) 115 mmHg.
C.) 104 mmHg.D.) 107 mmHg.
E.) 122 mmHg.

D.) 107 mmHg.

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Which ONE of the following is a correct statement describing transmission of the arterial pressure wave?

A.) It slows with increasing age.B.) It is caused in part by the inertia of blood in the aorta.
C.) It slows with increasing calcification of the vessels.
D.) It originates at the level of the arterioles.

B.) It is caused in part by the inertia of blood in the aorta.

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In laminar flow, the velocity of the blood is:
A.) Directly proportional to the cross-sectional area of the vessel.B.) Zero at the vessel wall.
C.) Highest at the vessel wall.
D.) Lowest at the center of the vessel.
E.) Lowest when kinetic energy is highest.

B.) Zero at the vessel wall. The fact that normal blood flow is zero at the vessl wall and highest at center stream is one reason why continuous- wave Dopplers show wider frequency shifts (decreased windowing) when spectrally analyzed.

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The principal site of peripheral resistance in the vascular bed is determined to be in the arterioles because:

A.) The blood flow is slowest in the arterioles.
B.) The blood pressure is highest here.C.) The pressure drop across these vessels is greatest.
D.) These vessels have thick muscular coats.
E.) The blood pressure does not change across these vessels.

C.) The pressure drop across these vessels is greatest.

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As the arterial pressure wave moves toward the periphery, all of the following occur except:a.) The pulse amplitude is increased by the presence of reflected waves.
b.) Speed of propagation diminishes.
c.) Pulsatile changes in arterioles and capillaries are "dampened" owing to vascular distensibility and resistance.
d.) Speed of propagation increases.

b.) Speed of propagation diminishes.

The incisura on the aortic pressure wave:A.) Is inscribed just after the aortic valve closes.
B.) Indicates closure of the AV valves.
C.) Results from aortic valve malfunction.
D.) Occurs during rapid ventricular filling.
E.) Occurs when the aortic valve opens.

A.) Is inscribed just after the aortic valve closes.

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Starling's law of the heart can best be expressed by which one of the following?
A.) As heart rate increases, ventricular contractility also increases.
B.) The product of heart rate and stroke volume equals the cardiac output.C.) Within limits, an increase in venous return results in an increase in stroke volume.
D.) Increasing the arterial pressure decreases the stroke volume.

C.) Within limits, an increase in venous return results in an increase in stroke volume.

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Which ONE of the following best describes the role of the heart as a pump?
A.) suctioning blood from the venous circulation.
B.) Regulating cardiac output.C.) Forcing blood from the venous to the arterial circulation, restoring energy necessary for the blood flow.

C.) Forcing blood from the venous to the arterial circulation, restoring energy necessary for the blood flow.